Healthcare Provider Details

I. General information

NPI: 1508157314
Provider Name (Legal Business Name): ANGEL JAMISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 DUDLEY AVENUE
CHERRY HILL NJ
08094
US

IV. Provider business mailing address

247 CHINKAPIN AVE
WILLIAMSTOWN NJ
08094-8522
US

V. Phone/Fax

Practice location:
  • Phone: 856-361-1100
  • Fax:
Mailing address:
  • Phone: 856-237-7821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NR11737400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: